[ERAS Guidelines] Pancreatoduodenectomy 胰臟及十二指腸手術(術前、術中、術後)臨床照顧建議指引

World Journal of Surgery 2020311日發布了胰臟及十二指腸手術(PancreatoduodenectomyERAS臨床照顧建議指引,此為2012初版的更新。ERAS society的專家小組整理了過去的文獻資料,透過實證醫學對27項處置給予 evidence level recommendation grade 的分級。


其中 high evidence level strong recommendation 的包含:

  • Preoperative biliary drainage should be avoided:避免常規術前引流以降低併發症,除非需 decompression (Bilirubin 過高、Cholangitis
  • Preoperative cessation of alcohol consumption術前4週戒酒
  • Preoperative nutritional intervention:體重掉>15%病人進行營養介入
  • Oral immunonutrition is not recommended:不建議免疫營養品
  • Anti-thrombotic prophylaxis:LMWH/UFH 降低靜脈血栓栓塞風險
  • Antimicrobial prophylaxis:下刀前一個小時內及術中給予抗生素
  • Wound catheter and transversus abdominis plane (TAP) block:Epidural 止痛的替代方案
  • Early removal of perianastomotic drainage建議於72小時內移除


論文連結:

Emmanuel Melloul et. al.
Published 11 March 2020